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In a rare move, the OIG rescinds a 2006 Advisory Opinion
Earlier this week, the Office of Inspector General (OIG) announced that it was rescinding an advisory opinion from 2006 which held that a patient assistance program (PAP) did not violate the anti-kickback statute. The rescission of an eleven-year-old advisory opinion underscores the importance of maintaining ongoing compliance of financial arrangements that have received OIG approval. read more
By: Colin Luke
DOJ Drops ManorCare Lawsuit over disgraced expert
In what can only be described as a crushing blow, the Department of Justice has been forced to drop a long-running False Claims Act prosecution against HCR ManorCare, Inc. , a short-term post-acute and long-term care provider, over the failure to disclose notes of its medical necessity expert that contravened her deposition testimony. read more
By: J.D. Thomas
AHA Report: Healthcare Providers are Being Crushed by Regulatory Burdens
A recent report published by the American Hospital Association highlights the struggle to balance administrative and compliance demands with patient care. read more
By: Denise Burke
Failure to Return Overpayment Credit Balances Results in a False Claims Act Settlement by Cardiovascular Practice
A Jacksonville cardiovascular practice entered into a $448,821 False Claims Act Settlement with the U. S. Attorney’s Office for the Middle District of Florida for failing to return overpayments within 60 days of identification as required by the False Claims Act. read more
By: Denise Burke
CSR Payment Update
Recent proposals impact on CSR payments and health insurance premiums read more
By: Colin Luke
District Court upholds first application of “Escobar materiality standard”
The U.S. District Court for the Western District of Pennsylvania has upheld the first application of the Escobar materiality standard in a False Claims Act case. read more
By: Alexander Mills
POTUS Trump Looks to Halt CSR Payments
On October 12, President Donald Trump announced that the federal government will halt payments known as cost share reduction (CSR) payments, used as a subsidy to enable lower-income Americans to afford health insurance coverage. read more
By: Colin Luke
Wellmont-Mountain States Granted Certificate of Public Advantage
Tennessee Dept. of Health issues certificate of public advantage greenlighting cooperative agreement between Wellmont Health System and Mountain States Health Alliance. read more
By: Kim Looney
HHS Ramps Up Investigation of Small-Scale HIPAA Br...
Following the settlement of a number of comparatively small patient privacy violations, HHS-OCR has directed its regional offices to take a more aggressive approach to breaches involving PHI of fewer than 500 individuals. read more
By: Colbey Reagan
CHOW Time: Change of Ownership Changes
Undergoing a Medicare Change of Ownership? Make Sure to Follow CMS’ Recent Changes to Post-Closing Payment Arrangements. read more
By: Colbey Reagan, Daniel Patten
CMS Proposes Change to Joint, Episodic, and Cardiac Rehabilitation Payment Models
Proposed rule could mean significant changes for CMS Innovation Center’s major payment models. read more
By: Patsy Powers, Daniel Patten
CMS Taps the Brakes on New Payment Models
CMS has published a proposed rule that will significantly scale back mandatory bundled payments models. read more
By: Denise Burke, Colin Luke
CMS v. U.S. Bankruptcy Courts - SCOTUS takes a pass
The U.S. Supreme Court won’t be taking sides in a turf war between CMS and U.S. bankruptcy courts. read more
By: Jeffery Parrish
CMS Reverses its Ban on Arbitration Agreements in Nursing Homes
CMS completely reversed its Obama-era view of nursing home arbitration agreements, and the reversal hardly came as a surprise. read more
By: Jeffery Parrish, Jeffrey Smith, Loribeth Westbrook
CBO Releases Highly Anticipated Report on Trump’s ObamaCare Repeal Bill; 23 Million Americans Projected to Lose Insurance by 2026
The Congressional Budget Office released its report on the American Health Care Act of 2017 (in its current state) and predictions include 23 Million Americans Losing Insurance by 2026 read more
By: Nora Liggett, Colin Luke
The Supreme Court Still Favors Arbitration
U.S. Supreme Court ruled that a nursing home can enforce arbitration agreements signed by persons with power of attorney over nursing home residents in the consolidated cases of Kindred Nursing Centers v. Clark et al. read more
By: Jeffery Parrish, Jeffrey Smith, Loribeth Westbrook
Reversing the Ban on Nursing Home Arbitration Agreements
CMS's announcement of a new rule banning arbitration clauses in nursing home admission contracts was premature as CMS would delay enforcement of the rule, citing legal challenges to arbitration agreements. read more
By: Jeffery Parrish, Jeffrey Smith, Loribeth Westbrook
House Passes Bill to Repeal the Affordable Care Act
Today, the U.S. House of Representatives passed a bill to repeal some key portions of the Affordable Care Act. The bill now goes to the Senate for a vote. read more
By: Nora Liggett, Colin Luke
Enforcement Trends: Five Lessons from Recent OCR Resolution Agreements and Other Enforcement Risks
Since January, the OCR has entered into two Resolution Agreements for HIPAA violations, one Resolution Agreement for failure to timely report a breach, and one of only three Civil Money Penalties imposed for HIPAA violations since 2009. read more
By: Elizabeth CHPC
Bundled Payments on the Back Burner
An interim final rule published by CMS has delayed the expansion of a number of bundled payment programs and initiatives. read more
By: Colin Luke
Healthcare Providers Must Stay Current with State Legislative Developments
Developments in the Tennessee statehouse could have immediate impact on healthcare providers in the Volunteer State. read more
By: Denise Burke, Jeffery Parrish, Catie Bailey
Proposed Rule from HHS Changes Standards for ACA Individual and Small Group Marketplaces
HHS issues Proposed Rule in one of the Trump Administration's first concrete developments related to the Affordable Care Act. read more
By: Neil Krugman
Medical Necessity Claims Fail to Satisfy FCA Falsity Standard
A federal court dismissed a False Claims Act case alleging that surgical procedures performed by a cardiologist were medically unnecessary and subsequent Medicare and Medicaid reimbursement for the procedures amounted to false claims as a result. read more
By: W. Bridgers, Andrew Warth, Wells Trompeter
Healthcare Industry on Pins and Needles: The Repeal of the ACA and What Comes Next
With the election of Donald Trump, and a Republican-controlled Congress, the repeal of the ACA is all but assured. It is not clear, however, what will come of the repeal of Obamacare and its replacement. read more
By: J.D. Thomas
DOJ posts more big numbers with 2016 FCA recoveries
For fiscal year 2016, the DOJ recovered $4.7 billion in settlements and judgments from civil cases involving the False Claims Act. More than half of the dollars recovered can be attributable to the healthcare industry. read more
By: J.D. Thomas
HHS Continues to Face Pressure over Inability to Clear Administrative Appeals
Healthcare providers who have to deal with administrative audits and recoupment requests are well aware that attempts to contest or challenge them can result in protracted wait times. read more
By: J.D. Thomas
OIG Authorizes Per-Dispense Fee for Vaccination Refrigeration Systems Located in Physician Offices
The Department of Health and Human Services Office of the Inspector (OIG ) recently issued an advisory opinion that determined that a vaccine storage and dispensing system with a per-dispense fee did not violate the Anti-Kickback Statute. read more
By: Nora Liggett
Federal Court Grants Preliminary Injunction against CMS’ New Nursing Home Arbitration Rule
The U.S. District Court for the Northern District of Mississippi granted a preliminary injunction which likely provides at least temporary respite for long-term care facilities amidst a recent flurry of new regulation. read more
By: Jeffery Parrish
CMS Finalizes Policies on Site-Neutral Payments for Off-Campus Provider-Based Departments
Changes to how off-campus provider-based departments are paid highlight 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System Final Rule. read more
By: Patsy Powers
Anesthesiologists and the Enforcement of Non-Competes: Is Reform on the Way?
Non-competes are generally disfavored as a matter of law and public policy, and a recent White House report advocates non-compete reform at the state and federal level. read more
By: Amanda Jester, Ashleigh VanLandingham
DOJ Sharpens Focus on Individual Wrongdoing with $1 Million Settlement and Four-Year Exclusion against Former CEO
On September 27, the DOJ, in conjunction with HHS-OIG, entered into a settlement agreement with former Tuomey Healthcare System CEO Ralph J. Cox III for alleged violations of the Stark Law. read more
By: Kim Looney
What Clinicians Need to Know About 2017 Reporting under the New Medicare Quality Payment Program
HHS has released the final rule outlining implementation of the MACRA Quality Payment Program which applies to clinicians or groups with more than $30,000 in Medicare Part B allowed charges and more than 100 Medicare patients. read more
By: Elizabeth CHPC
HHS Imposes Steep Adjustment of Civil Monetary Penalties for Skilled Nursing Facilities and Home Health Agencies
Healthcare providers cited for violations of federal regulatory requirements – and particularly skilled nursing facilities and home health agencies – will face increased civil monetary penalties read more
By: Jeffery Parrish
CMS Bans Pre-Dispute Arbitration Agreements at Long-Term Care Facilities
CMS has issued a final rule that bans all pre-dispute arbitration agreements at long-term care facilities that participate in Medicare or Medicaid programs. read more
By: Jeffery Parrish
Tennessee Task Force Will Study the Role of APRNs
In an effort to confront healthcare access and cost concerns facing its residents, the State of Tennessee recently initiated a task force to examine an issue that many states are readdressing – the scope of practice for mid-level practitioners. read more
By: Kim Looney
HHS Ramps Up Investigation of Small-Scale HIPAA Breaches
Following the settlement of a number of comparatively small patient privacy violations, HHS-OCR has directed its regional offices to take a more aggressive approach to breaches involving PHI of fewer than 500 individuals. read more
By: Colbey Reagan
$2.95 Million Settlement May Mark Turning Point in Enforcement of the 60-Day Rule
A $2.95 million settlement represents one of the first settlements for the failure to return overpayments within the 60-day window since promulgation of the February 2016 final rule. read more
By: Patsy Powers, Alexander Mills
Recent Cases Offer Increased Prospects for Mergers by Competing Hospitals
Recent setbacks experienced by the FTC in hospital merger challenges may embolden hospitals and health systems considering potential combinations. read more
By: Beth Vessel
Oncology Providers Beware: Possible Implications of CMS’ Proposed Rule on Off-Campus Provider-Based Departments
Providers of oncology services should be aware of several provisions included in CMS' proposed rule intended to prohibit hospitals operating certain off-campus provider-based departments from billing under the Outpatient Prospective Payment System. read more
By: Brent Bowman
Many Questions Left Unanswered in the Wake of Long-awaited CMS Proposed Rule Regarding Off-Campus Provider-Based Departments
Many providers have serious concerns about CMS' proposal to prohibit hospitals operating certain off-campus provider-based departments from billing under the Outpatient Prospective Payment System. read more
By: Alexander Mills
More Belt-Tightening for Home Health Providers as CMS Proposes Update to Prospective Payment System
The home health industry could see its profit margins shrink further as a result of proposed updates to the Home Health Prospective Payment System released by the Centers for Medicare & Medicaid Services earlier this week. read more
By: Alexander Mills
Department of Labor “Persuader Rule” Put on Hold
Yesterday, a federal judge in Texas entered a nationwide injunction barring the Department of Labor from enforcing the "Persuader Rule." read more
By: Mark Peters
Supreme Court Declines Case Challenging DOL Home Care Wage and Hour Rule
The United States Supreme Court declined yesterday to hear arguments in Home Care Association of America, et al. v. Weil, a case challenging the Department of Labor’s Final Rule that extended overtime and minimum wage protections read more
By: Mark Peters
The Supreme Court Upholds the Implied Certification Theory of Liability in False Claims Act Cases, Raises New Questions
Yesterday, the Supreme Court issued a key decision that impacts the viability of the implied certification theory of liability in FCA cases. read more
By: J.D. Thomas
Roundtable Discussion Provides Insights on State of Data Interoperability in Healthcare
Joined by healthcare IT companies, investors, providers and payors, Waller co-hosted a roundtable discussion on interoperability with Brentwood Capital Advisors. Participants discussed the barriers, opportunities and goals around interoperability. read more
HHS Issues Proposed Rule for MACRA Quality Payment Program
Following up on the passage of the MACRA, HHS recently issued a proposed rule to replace the Medicare sustainable growth rate methodology which was repealed by MACRA. read more
By: Elizabeth CHPC
International Trade Commission Rules Against Imported Dental Implants
The U.S. International Trade Commission has concluded that certain dental implants infringe U.S. Patents and should be blocked from entry into the United States. read more
By: Matthew Cox
Guilt by Affiliation? Proposed Rule Would Expand CMS Program Integrity Authority
Last month, CMS issued a proposed rule that would drastically expand the agency’s authority to further its program integrity efforts through the provider and supplier enrollment process. read more
By: Caitlyn Page, J.D. Thomas
Flurry of Activity Signals FTC’s Ongoing Interest in Healthcare Transactions
A number of events have occurred recently involving the Federal Trade Commission and healthcare entities. read more
By: Beth Vessel, Ashleigh VanLandingham
CMS Says “the Future Is Now” with Comprehensive Primary Care Plus Announcement
The Centers for Medicare & Medicaid Services announced yesterday that it is launching a new initiative that “represents the future of health care.” read more
By: Denise Burke
DOJ Announces Elder Justice Task Force Locations, Including Nashville and Middle Tennessee
The Department of Justice announced a major new initiative to target quality of care and fraud and abuse in elder care by forming 10 Elder Justice Task Forces read more
By: J.D. Thomas
Recent Developments in Hospice Fraud and Abuse
The past week has seen some interesting developments for hospice providers in the world of fraud and abuse. read more
By: J.D. Thomas
OCR Announces Phase 2 HIPAA Audit Program
Under the 2016 Phase 2 HIPAA Audit Program, OCR will review policies and procedures adopted and employed by covered entities and business associates to comply with the applicable requirements of the HIPAA Privacy, Security & Breach Notification Rules read more
By: Kevin Page
CMS Releases 2016 Value-Based Payment Modifier Program Results for Physicians
CMS released results for the Value-based Payment Modifier Program which provides for differential payment to physicians and physician groups under the Medicare Physician Fee Schedule. read more
By: Caitlyn Page
Election Year Politics and Ongoing Transformation of Healthcare: A Recap of the LHC Delegation to D.C.
In an election year, it’s easy to imagine D.C. being focused on the next President. Hearing from presenters at Leadership Health Care’s annual D.C. delegation, however, a lot is happening in our nation’s capital to advance healthcare. read more
By: J.D. Thomas, Morgan Ribeiro
CMS Commences Cycle 2 of the Medicare Provider and Supplier Revalidation Process
On March 1, 2016, CMS announced the beginning of Cycle 2 of the revalidation process, which requires all Medicare providers and suppliers to resubmit and recertify the accuracy of their enrollment information on a regular and periodic basis. read more
By: Brandon Schirg
Push for Interoperability Grows with a Series of Recent Announcements
Last week, a pledge was announced at HIMSS by many of the industry’s vendors, providers and professional organizations to band together and push for interoperability. This follows similar announcements made by the federal government and agencies. read more
From Measuring “Clicks” to Measuring Performance
CMS administrators Andy Slavitt and Karen DeSalvo have made numerous comments recently about the future of meaningful use and other government initiatives around data governance. read more
By: Elizabeth CHPC
Speakers Address Key Issues for Long Term Care Providers at AHLA Event
Long term care providers and attorneys have come together this week at the AHLA Long Term Care and the Law summit. Speakers have provided insight on the regulatory landscape and emphasized the increasing importance of compliance. read more
By: J.D. Thomas
Justice Department Enforcement Efforts Continue to Focus on Home Health
When trying to understand how the government chooses where to focus its efforts regarding healthcare fraud, it is a safe bet they will follow the money. Given this, the government's interest in home health services is not surprising. read more
Sixth Circuit Severely Narrows Available Damages Under the False Claims Act
The Sixth Circuit has once again narrowed the damages available to the government in FCA cases. While the immediate ramifications of this decision will be felt in the contracting fraud arena, it also has implications for healthcare fraud and abuse. read more
By: J.D. Thomas
CMS Finalizes Rule Implementing the ACA’s 60-Day Report and Return Provision for Self-Identified Overpayments
CMS has published its final rule implementing the Affordable Care Act's 60-day report and return provision for self-identified overpayments. This publication offers much needed clarity for healthcare providers. read more
By: Daniel Patten
FTC Administrative Actions and Comments Indicate Shifting Landscape for Hospitals and Other Providers
Last year was a busy year for FTC as it continued to increase its focus on mergers involving healthcare providers. read more
By: Beth Vessel, Ashleigh VanLandingham
FDA Takes On 2016’s Ubiquitous Issue: Cybersecurity
Late last year, President Obama signed the Cybersecurity Act of 2015 into law, and more recently, the FDA issued a Draft Guidance regarding cybersecurity in medical devices. read more
By: Kristen Johns
Hospitals Celebrate Major Victory in Fight Related to RAC Appeals Backlog
The Court of Appeals for the D.C. Circuit yesterday reversed the lower court’s dismissal of a lawsuit seeking a writ of mandamus, a court order compelling HHS to work more quickly through the ever growing backlog of administrative appeals stemming read more
By: J.D. Thomas
Bundled Payments: Are They Finally Here?
Healthcare providers are attempting to move toward population health. But without a mandate, progress to date has been slow. This will soon change with CMS' CCJR Model, which will go into effect on April 1, 2016. read more
By: Colin Luke
DOL Final Rule Impacts Home Health “Companionship Services” Exemption
The DOL began enforcing its Final Rule extending overtime and minimum-wage protections to most home care workers previously deemed exempt in January. The home health industry has been busy looking for ways to minimize the impact of the DOL decision. read more
By: Mark Peters
Supreme Court Evaluating Implied Certification in FCA Cases
On December 4th, the Supreme Court announced it would hear arguments in Universal Health Services, Inc. v. United States ex rel. Escobar, which will consider the viability of implied certification. read more
By: J.D. Thomas
FTC Continues Focus on Healthcare Transactions with Penn State Hershey Merger
Continuing its active review of healthcare transactions, on December 8, the FTC authorized an administrative action to block Penn State Hershey Medical Center’s proposed merger with PinnacleHealth System. read more
By: Beth Vessel
Hospitals Hit Hard in 2015 False Claims Act Enforcement
Last week, the DOJ announced another multi-billion dollar yearly haul from FCA enforcement -- totaling over $3.5 billion for FY 2015. Of that total, the majority came from the healthcare industry. read more
By: J.D. Thomas
Supreme Court Weighs ERISA Preemption and Health Data Collection
U.S. Supreme Court heard oral arguments in a case that centers around a state law requiring health insurers to provide data on medical claims, pharmacy claims, member eligibility, etc. read more
By: M. Sullivan
Recruiting and Employing International Medical Graduates Post Medical Training
Today, approximately one in four physicians practicing in the United States obtained his or her medical education outside the U.S. Despite this fact, some hospitals and health systems are reluctant to recruit and hire international medical graduates. read more
By: Vinh Duong, Nora Katz
Deputy Attorney General Yates Elaborates on Individual Accountability for Corporate Wrongdoing
Deputy Attorney General Sally Quillian Yates' remarks on the "Yates Memorandum" should be of interest to companies in the healthcare industry. read more
Recent FTC Administrative Decisions and Comments Indicate Shifting Landscape For Hospitals
In the latest example of their involvement in hospital transactions, the FTC filed an administrative complaint last week regarding a WV deal. read more
By: Beth Vessel
Clinical Co-Management Agreements Offer Opportunity for Physician Alignment
Clinical co-management agreements offer an opportunity to align the interests of hospitals and practicing physicians in order to achieve better clinical outcomes and patient satisfaction. read more
By: Colin Luke
Doctors and Hospitals Face Cuts in the Proposed Budget Deal
The House and Senate have passed a two-year $80 billion budget deal, which would limit future payment rates for hospitals that set up or buy off-campus facilities. read more
By: Brandon Schirg
Real Estate as a Tool for Improving Physician Alignment
Today, every hospital and health system is looking for strategic opportunities to improve its alignment with physicians. These efforts often involve the acquisition of physician practices, employment of physicians and strategic joint ventures. read more
By: Jeffrey Calk
Community Health Needs Assessments and Implementation: The Board’s Ongoing Responsibility
Many healthcare boards believe they have satisfied the 501(r) CHNA requirements by completing their organization’s CHNA report and adopting an implementation strategy but that's only the beginning. read more
By: Donald Stuart
Relief for 2015 Meaningful Use Reporting but Stage 3 Final Rule Future is Uncertain
Earlier this week, after considering more than 2,500 comments, CMS released the much anticipated Final Rule for EHR Incentive Program - Stage 3 and Modifications to Meaningful Use in 2015 and 2017. read more
By: Elizabeth CHPC
OIG Takes Aim at Skilled Nursing Therapy Billing
The Department of Health and Human Services’ Office of Inspector General issued a report, “The Medicare Payment System for Skilled Nursing Facilities Needs To Be Reevaluated,” in which the OIG was very critical of SNF therapy billing. read more
By: Jeffery Parrish
Thoughts from the 2015 AHLA Fraud and Compliance Forum
Once again, AHLA outdid itself and put on an excellent program at the 2015 Fraud and Compliance Forum. The program combined a unique mix of speakers from government, in-house legal and compliance personnel and outside counsel with timely and interest read more
By: J.D. Thomas
OIG Recommends Strengthening OCR Oversight of HIPAA Privacy and Breach Follow-up
The Office of Inspector General (OIG) recently released two reports recommending that the Office of Civil Rights (OCR) strengthen (1) its oversight of covered entity compliance with HIPAA privacy standards, and (2) its follow-up of reported breaches read more
By: Elizabeth CHPC
Healthcare Data Analytics Patent Subject to “CBM” Review at USPTO
On September 10, 2015 in the case Symphony Health Solutions Corp. v. IMS Health Inc., (CBM2015-00085) the U.S. Patent Trial and Appeal Board (“PTAB”) granted institution of a Covered Business Method (CBM) review read more
By: Matthew Cox, R. Walker Jr.
AHLA’s Fraud and Compliance Forum Kicks Off with Keynote Speech from Joyce Branda, Deputy Assistant Attorney General
Deputy Assistant AG Joyce Branda provided an update on the DOJ's enforcement and litigation of the False Claims Act at the AHLA's annual Fraud and Compliance Forum. read more
By: J.D. Thomas
Extension of Public Comment Period Speaks to Impact of NIST’s Healthcare-Focused Cybersecurity Guide
The NCCOE has recently extended the comment period its recent guide, which serves as one of the most comprehensive manuals to address the protection of patient information records, with a particular focus on securing mobile technology. read more
By: Julian IV, Kristen Johns
Stark Settlement Dominoes Beginning to Fall in the Aftermath of Tuomey
In the last two weeks the practical effects of Tuomey have become clear with the Department of Justice announcing two record-breaking False Claims Act settlements related to Stark Law violations. read more
By: J.D. Thomas
HRSA: At long last, "mega-guidance" on 340B program
The long-awaited “mega-guidance” recently proposed by HRSA attempts to clarify several important aspects of the 340B Drug Pricing Program. read more
By: John Arnold
Zero to Sixty: The Overpayments Clock Is Ticking and the Courts Are Keeping Time
The healthcare industry recently saw the first reported court opinion in a False Claims Act case involving the 60-day rule for overpayments. read more
By: J.D. Thomas, Jennifer Weaver
Meaningful Use Rules Under Review by the OMB
CMS sent the long-awaited final rule that modifies the requirements of the Meaningful Use program Stages 1 and 2, as well as the rule implementing Stage 3, to the OMB. read more
By: Elizabeth CHPC
DOL Asks D.C. Circ. for Quick Approval of Home Care Rule
Since October 2013, when the Department of Labor issued a Final Rule extending overtime and minimum-wage protections to most home care workers previously deemed exempt, the home health industry has been on pins and needles. read more
By: Mark Peters
FTC Releases Guidelines Regarding Unfair Methods of Competition
On August 13, 2015, the FTC released its Statement of Enforcement Principles Regarding Unfair Methods of Competition Under the FTC Act. read more
By: Beth Vessel
Hospital Board Members and Trustees Can be an Effective Ally for the CEO
Last week, we presented on the challenges faced by hospital boards at the annual Healthcare Governance Conference presented by Texas Healthcare Trustees. Rural hospitals in Texas and elsewhere face more legal and financial challenges than ever before read more
By: Fletcher Brown
CMS Issues Proposed Stark Law Modifications
In July, CMS published a draft update to the Medicare Physician Fee Schedule for 2016, which included proposals that aim “to reduce burden and to facilitate compliance” under the physician self-referral law known as the Stark Law. read more
By: Kristen Larremore
New Jersey Case Wakes Up the Nonprofit Hospital Industry - What the Morristown Case Means for Hospital Property Tax Exemptions
Nonprofit hospital executives and lawyers throughout the country have been taking notice of a recent tax court case out of New Jersey involving the Morristown Medical Center. read more
By: Donald Stuart
Senator Grassley Takes Notice of OIG Reports Alleging Fraud in Pediatric Dental Practices
Sen. Grassley recently sent a letter to United States Attorney General Loretta Lynch asking her to detail the DOJ’s investigation and enforcement efforts with regard to Medicaid dental fraud. read more
By: J.D. Thomas
A Healthy Dose of Data Security Awareness
At Waller’s latest Healthcare and Big Data panel discussion, we were joined by industry experts to discuss healthcare data breaches. While data security threats arise in a variety of contexts, the risk of healthcare data breaches can be reduced read more
CMS Prepared to Modify Controversial Two-Midnight Rule
Earlier this month, CMS released the Hospital Outpatient Prospective Payment System (HOPPS) Proposed Rule for CY 2016. While there are a number of payment updates proposed in the plan, the two-midnight rule is garnering most of the attention. read more
By: Fletcher Brown, J.D. Thomas
Tuomey Decision Signals Concerns About Stark Law
Earlier this month, the Fourth Circuit federal appeals court upheld a district court’s $237 million FCA verdict against Tuomey Healthcare System for Stark Law violations. The sum is believed to be the largest ever levied against a community hospita read more
By: J.D. Thomas
What CMS’ Proposed Bundled Payment Rule for Elective Hip and Knee Replacements Could Mean for Providers
Yesterday, CMS published a proposed rule - called the Comprehensive Care for Joint Replacement (CCJR) Model - which would implement a mandatory bundled payment program for elective hip and knee replacements in 75 geographical areas. read more
By: Denise Burke, G. Bickley
House Passes 21st Century Cures Act
Today, the U.S. House of Representatives passed H.R. 6, the 21st Century Cures Act, with a bipartisan vote of 344-77. The legislation is intended to accelerate “the discovery, development and delivery of life saving and life improving therapies.” read more
Tom Scully Highlights Need for Post-Acute Care Reform at Leadership Health Care
Recently, Nashville’s Leadership Health Care hosted several healthcare leaders to hear Tom Scully, general partner at private equity firm Welsh, Carson, Anderson & Stowe and chairman of naviHealth, on the state of the post-acute space read more
By: J.D. Thomas
Supreme Court Saves Affordable Care Act (Again): 6-3 Decision Upholds Subsidies in King v. Burwell
6.5 Million Americans, 34 States, Investors (and Maybe Even Republicans) Breathe Collective Sigh of Relief read more
King v. Burwell - Supreme Court Affirms Fourth Circuit Decision in Favor of Nationwide Subsidies
In a 6-3 decision, the Supreme Court affirmed the Fourth Circuit decision in King v. Burwell. The majority opinion noted that "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them." read more
OIG Issues Fraud Alert Targeting Physician Compensation
The Office of the Inspector General issued a Fraud Alert on June 9, 2015 that highlights the OIG’s intent to continue and to strengthen its focus on physicians who enter into questionable compensation arrangements with hospitals read more
Congress Opens the Medicare Data Toolbox
The “Doc Fix” law includes a few subtle lines that may expand the use of Medicare claims data to develop new models of patient care. read more
Long Sentences in Healthcare Fraud and Other White Collar Cases Combined with Increased Criminal Investigation of False Claims Act Cases Make for a Potentially Explosive Combination
Last week the former president of Riverside General Hospital in Houston was sentenced to 45 years in prison and ordered to pay restitution in excess of $46 million for his role in a $158 million Medicare fraud scheme read more
By: J.D. Thomas
Setting the Stage for Interoperability
The “Doc Fix” got most of the coverage when Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), but the bill also established numerous requirements and deadlines with respect to achieving interoperability read more
OIG Issues Latest Report Targeting Dental Providers
The Office of the Inspector General (OIG) has issued its latest report in its state-by-state series examining pediatric dental services provided under Medicaid. This newest report examines such practices in California. read more
By: J.D. Thomas
What Hospitals Can Learn from Recent Florida Settlements over Ambulance Rides
The U.S. Attorney's Office for the Middle District of Florida announced that nine Florida hospitals have agreed to pay $6.2 million to settle allegations that they led ambulance companies to bill for medically unnecessary rides. read more
By: J.D. Thomas
Advocates and Critics Contemplate 21st Century Cures Act
Over the last year, the U.S. House Energy and Commerce (E&C) Committee has engaged in a broad public conversation about what steps can be taken to bridge the gap between advancements in science and the approval of new medical therapies read more
New Tennessee Law Provides Patient Access to Interchangeable Biologic Medicines
Tennessee Governor Bill Haslam this week signed TN Senate Bill 984 into law, creating a clear pathway for pharmacists in Tennessee to substitute an FDA-approved “interchangeable biological product” for a prescribed biological product. read more
By: L. Rost Jr.
Financial Experts Discuss Deal-Making Trends
Recent reports continue to show that deal volume in the healthcare industry is at an all-time high. The Nashville Health Care Council continued this ongoing discussion during its “Financing the Deal” event. read more
By: Morgan Ribeiro
Creating a Mutually Beneficial Relationship between Innovators and Institutions
Medical and administrative know-how and inventions are positively impacting patient care, patient costs and hospital revenue. Yet almost all of the formalized programs to transfer technology are within major university-affiliated hospitals. read more
By: Kristen Johns
April Showers Brought Changes to Telehealth Laws
Telehealth is exploding in both popularity and use as it has been shown to be convenient, affordable and of high quality. On both a federal and Tennessee level, the field of telehealth continues to gain attention and garner changes in the law. read more
Considerations for Hospitals and Health Systems on Commercializing Innovations
One opportunity that is sometimes overlooked by health systems is the commercialization of innovations conceived by the physicians and staff providing care. read more
By: Kristen Johns
Obama Administration Warns States that Failing to Expand Medicaid Could Jeopardize Funding to Pay for Treating the Poor
Tennessee was recently added to the list of states that have been warned by the Obama administration that failing to expand Medicaid under the Affordable Care Act could jeopardize special funding to pay providers for treating the poor. read more
The Rise of Hospital Joint Ventures: A Q&A with Juniper Advisory’s Rex Burgdorfer
Hospital joint ventures have progressed significantly over the past several years; they are now a viable option to help organizations provide services or enter markets they would otherwise be unable to access. read more
By: W. Marlow
Fade to Black … for Now? The Twisting Tale of Telemedicine in Texas
On Friday, April 10, the Texas Medical Board voted to limit severely the ability of physicians in the state to provide two fundamental components of primary medical care via telemedicine. read more
Tips on and Trends in Healthcare IT Investments
On Tuesday, Waller hosted the second installment of our Healthcare and Big Data panel series. We were joined by Vic Gatto of Jumpstart Foundry, Jesse Bland of the Heritage Group, and William Seibels of Change Healthcare. read more
By: Robert Harris, G. Bickley
Hurry Up and Wait: Senate Says “Not So Fast” to the Sustainable Growth Rate Bill
After yesterday’s passage by the U.S. House of a bill eliminating the sustainable growth-rate (“SGR”) formula (otherwise known as the “doc fix”), the Senate leaders decided they’d rather think about the bill after Spring Break. read more
Biosimilars on the Agenda as Life Science Tennessee Visits the State Legislature
Members of Life Science Tennessee were in Nashville yesterday for the organization’s annual legislative “Day on the Hill” at the Tennessee General Assembly. A key element of the group’s state policy agenda focuses on “biosimilars". read more
By: L. Rost Jr.
MedPAC Issues 2015 Report to Congress
Last week, MedPAC – the Medicare Payment Advisory Commission – issued its annual report to Congress on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage program, and the Medicare prescription drug program (Part D). read more
By: Denise Burke
An Update from Leadership Health Care’s Delegation to D.C.
Earlier this week, we attended the Leadership Health Care delegation to Washington, D.C., where we were joined by 100 of our fellow Nashville healthcare industry friends to learn more about the policy and politics shaping our industry this year. read more
By: J.D. Thomas
Tufts Health Plan Announces New Hampshire Joint Venture with Granite Healthcare Network
Earlier this week, Tufts Health Plan announced that it will create a New Hampshire-based insurance company called Tufts Health Freedom Plan in a joint venture with Granite Healthcare Network (GHN). read more
By: Brian Browder
Has the Supreme Court Opened a Door for New Challenges to State Corporate Practice of Medicine Laws?
The Supreme Court’s recent 6-3 decision in North Carolina Board of Dental Examiners v. Federal Trade Commission is noteworthy for its possible effects on the way state boards or agencies license and regulate dental and medical practitioners. read more
By: Neil Krugman, Donald Moody
Four Little Words and a Potential “Death Spiral” - Supreme Court Hears Challenge to Affordable Care Act Subsidies in King v. Burwell
The Supreme Court heard oral arguments in King v. Burwell this week. The subsidies at issue in the case are a critical piece of the ACA's architecture that a ruling for the petitioners would likely be the death knell for the ACA itself. read more
Alignment Continues for Providers and Insurers
More providers are partnering with payors to position themselves for population health management. We foresee several potential obstacles, however, to the success of this collaboration among competitors. read more
By: Brian Browder
Denial of St. Luke's Appeal Shows Importance of Competitive Review of Transactions
In a widely anticipated decision, the Ninth Circuit affirmed the decision of the U.S. District Court for the District of Idaho ordering divestiture of St. Luke’s 2012 acquisition of Nampa, Idaho-based Saltzer Medical Group. read more
By: Beth Vessel
Healthcare Fraud Enforcement and the DOJ’s Greatest Hits
In 2014, the department of justice obtained $2.3 billion in healthcare fraud recoveries and 2015 will be another significant year for False Claims Act enforcement - particularly as it relates to hospitals and associated providers. read more
By: J.D. Thomas
Data Analytics is (Still) the Next Big Thing
My not-so-bold prediction for 2015 is that it’ll be a busy year for the healthcare data analytics business. I admit that making 2015 predictions now is a little like placing a bet after the horses have run the first quarter mile... read more
CMS Flinches on Meaningful Use
Five years after the HITECH Act, the meaningful use incentive program for electronic health records (EHRs) is still confusing providers. read more
By: Denise Burke
Key Takeaways from the Annual JP Morgan Conference
At the annual JP Morgan Healthcare Conference, we gained some key insights about the year ahead for the industry and what we can expect from investors and other key players. read more
By: Robert Harris
EHRs, Data Integrity and the Critical Need for a Data Governance Plan
The American Health Information Management Association (AHIMA) highlights the importance of data integrity, saying that trust plays a critical role in healthcare delivery and that trust depends on the completeness and correctness of data. read more
From Here to There: What It Will Take to Achieve the Goals of Population Health
The primary goal of population health strategies is getting the different, more or less isolated, parts of healthcare ecosystem to come together into a loosely affiliated group. This is a not controversial idea. read more
By: E. Norwood
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