Articles and Blogs

Health care providers and practitioners in most states are well aware that most Medicaid and CHIP enrollees are members of managed care organizations (“MCOs”). As states have increasingly contracted with and relied on MCOs for their growing Medicaid and CHIP populations, including enrollees who need and use long-term care services, the Centers for Medicare... READ MORE

Executive Summary On May 28, 2015, the Office of the Inspector General (“OIG”) published a mid-year update to its Fiscal Year (“FY”) 2015 Work Plan (“Updated Plan”).  The Updated Plan identifies certain new projects that OIG started since, and that did not appear in, the original FY 2015 Work Plan published in October 2014.  OIG... READ MORE

On May 19, 2015, the Subcommittee on Health of the House of Representatives Committee on Ways and Means, chaired by Kevin Brady (R-TX), held a hearing titled Improving Competition in Medicare: Removing Moratoria and Expanding Access. The hearing was the first in a series for the summer that is intended to identify solutions to... READ MORE

On April 27, 2015, the U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) announced that it entered into a settlement with a Colorado pharmacy (“Pharmacy”) arising from alleged violations of the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy Rule.  Under the settlement, the Pharmacy agreed to pay $125,000 in... READ MORE

On April 20, 2015, the Office of Inspector General (“OIG”), in collaboration with the American Health Law Association, the Association of Healthcare Internal Auditors and the Health Care Compliance Association, released Practical Guidance for Health Care Governing Boards on Compliance Oversight (the “Board Guidance”). The Board Guidance offers practical tips for governing boards of... READ MORE

Facts of an Interesting Telemedicine Case1 The plaintiff in the case (“Physician”) is a board-certified radiologist who entered into a contract with defendant teleradiology company (“Company”) to furnish teleradiology services to hospitals, including a hospital on Long Island, New York (“Hospital”).  Under the terms of the contract, Hospital would electronically transmit diagnostic images, such as X-rays,... READ MORE

Hospital organizations that are tax exempt pursuant to Code Section 501(c)(3) can face significant penalties for failures to comply with Code Section 501(r) and the related final regulations.  Fortunately, in drafting the final regulations, the IRS and Treasury Department acknowledged that even the most diligent hospital organizations may experience unintentional failures due to the... READ MORE

On March 20, 2015, Governor John Hickenlooper signed House Bill 15-1029 into law, expanding coverage for telehealth by requiring health insurers to provide reimbursement for telehealth services at the same level as in-person services in urban as well as rural areas beginning in 2017.  Previously, Colorado law only required reimbursement for telehealth services provided... READ MORE

Executive Summary April 16, 2015 is National Healthcare Decisions Day. The goal of the day is to encourage Americans to think and talk about their health care goals and communicate their health care decisions by executing advance health care directives.  READ MORE

Executive Summary On Tuesday, March 24, 2015, representatives from the Government Accountability Office (“GAO”), the Department of Health and Human Services Office of the Inspector General (“OIG”) and the Health Resources Services Administration (“HRSA”) testified regarding the drug discount program authorized by Section 340B of the Public Health Services Act (“340B Program”).  The testimony... READ MORE