Articles and Blogs

Executive Summary On February 11, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued its long-awaited Final Rule (“Final Rule”) implementing the overpayment reporting and repayment provisions of the Patient Protection and Affordable Care Act (“PPACA”). The Final Rule clarifies certain provisions set out in the February 14, 2012 Proposed Rule (“Proposed Rule”),... READ MORE

As a result of legislation passed by the Indiana General Assembly in 2014, two important property tax dates are changing for 2016 and going forward. READ MORE

Background The Hart-Scott-Rodino Antitrust Improvements Act of 1976 (“HSR”), as amended, requires all persons contemplating certain mergers or acquisitions that meet or exceed the jurisdictional thresholds (shown below) to file notification with the Federal Trade Commission (“FTC”) and Department of Justice (“DOJ”) Antitrust Division and to wait a period of time before consummating the... READ MORE

As lawmakers return for the second session of the 114th Congress, physician-owned hospitals (“POHs”) across the country are closely watching the status of the Promoting Access, Competition, and Equity Act of 2015 (H.R. 2513) authored by Rep. Sam Johnson (R-TX). Also referred to as the PACE Act of 2015, H.R. 2513 would change existing... READ MORE

This week, the Centers for Medicare & Medicaid Services (“CMS”) posted a much-anticipated FAQ related to off-campus provider-based departments and use of the “PO” modifier. Reporting of the modifier was voluntary in CY 2015 but mandatory beginning in CY 2016. CMS clarified that the “PO” modifier is only required for items and services provided... READ MORE

Executive Summary On December 30, 2015, the Pennsylvania Commonwealth Court struck down a provision of the Older Adults Protective Services Act that barred individuals convicted of certain crimes, such as murder and rape, from working in nursing homes or other health care facilities serving the elderly. In Tyrone Peake et. al. v. Commonwealth of... READ MORE

The Department of Health and Human Services Office of Inspector General (“OIG”) is currently soliciting proposals and recommendations for additional Anti-Kickback Statute safe harbors and OIG Special Fraud Alerts.1 The Health Insurance Portability and Accountability Act requires an annual notice period to solicit these comments in order to identify and protect non-abusive arrangements from the... READ MORE

Executive Summary Riding the wave of an unprecedented winning streak and continuing its trend of aggressive antitrust enforcement in the hospital merger arena, the FTC recently challenged three proposed hospital mergers – one in West Virginia, one in Pennsylvania and one in Chicago, Illinois – in a two-month period.  In each challenge, the FTC... READ MORE

In an opinion filed January 5, 2016, the Illinois Fourth District Appellate Court ruled that the Illinois statute authorizing hospital property tax exemptions is unconstitutional. Until formal guidance is released from the Illinois Department of Revenue, this decision will likely create a period of uncertainty for hospitals that have secured or that are seeking... READ MORE

Executive Summary On December 18, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released a draft Quality Measure Development Plan (“Draft Plan”) to serve as a strategic framework for the future of clinician quality measure development for the transition to new Merit-Based Incentive Payment System (“MIPS”) and alternative payment models (“APMs”).1 The Draft... READ MORE