Articles and Blogs

Code Section 501(r) and its corresponding regulations will pose significant challenges for tax-exempt hospital organizations in 2015 and beyond.  While operational personnel will shoulder much of the implementation burden, hospital CEOs and board members must have a general understanding of the new requirements to ensure that the compliance efforts proceed on schedule and to... READ MORE

On March 4, 2015, the Centers for Medicare & Medicaid Services (“CMS”) announced a voluntary Self-Referral Disclosure Protocol (“SRDP”) that will allow physician-owned hospitals and rural providers an alternative way to remedy certain issues of noncompliance with the federal Stark Law (“Stark Law”).1  CMS has provided special instructions regarding a voluntary SRDP for physician-owned hospitals... READ MORE

The Fourth District of the Appellate Court of Illinois reaffirmed that claims by a physician that a hospital’s failure to renew his privileges caused actual and intentional harm to his professional reputation are barred by the Illinois’s Hospital Licensing Act. Only claims alleging an actual or deliberate intention to physically harm the physician or others trump a hospital’s... READ MORE

The Third Circuit Court of Appeals¹ became the third federal appeals court in one week to issue an opinion regarding the False Claims Act’s Public Disclosure Bar.² In a non-precedential opinion, the Third Circuit affirmed the dismissal of a pharmacist’s allegations finding the allegations were based on public information for which the Relator was not... READ MORE

Earlier today, at an annual meeting of tax professionals, Internal Revenue Service (“IRS”) TE/GE Commissioner Sunita Lough remarked that the IRS recently completed and provided Congress a report on the activities of tax-exempt and other hospitals. Under Internal Revenue Code Section 4959, the Treasury Department or its designee must review the community benefit activities of every Code Section 501(c)(3) hospital at... READ MORE

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinion 15-01,1 which provided a favorable opinion of an arrangement that offered Medicaid beneficiaries free diapers and playpens if the beneficiaries chose a provider’s program for the state’s Maternal Infant Health Program (“Arrangement”). OIG found that the Arrangement did... READ MORE

Executive Summary In response to the 2012 meningitis outbreak traced to tainted injections compounded by the New England Compounding Center, OIG recently published a study entitled “Medicare’s Oversight of Compounded Pharmaceuticals Used in Hospitals: OEI-1-13-0040” (“Study”).  OIG made the following findings: State survey agencies and accreditation agencies (e.g., The Joint Commission, HFAP, DNV, Center... READ MORE

OIG recently issued Advisory Opinion 15-02, which clarified OIG’s position on when federal health care program payments to an excluded individual could be permissible. The proposed arrangement involved a physician who had an ownership interest in a group medical practice. The group practice billed federal health care programs for services the physician performed before... READ MORE

CMS recently issued Advisory Opinion CMS-AO-2014-01 (“Opinion”)1 evaluating the methodology used to determine the percentage of the requesting hospital’s physician ownership as of March 23, 2010 (“Baseline Physician Ownership”).  Even though the requesting hospital executed a contribution agreement prior to March 23, 2010, CMS concluded that such action did not affect the percentage of Baseline... READ MORE

By this point, it is no secret that the federal and state antitrust enforcers are suspicious of providers’ rationales for the provider consolidation wave hitting the health care industry.  In their view, provider consolidation in highly concentrated markets leads to increased prices for hospital and physician services paid by commercial payers, which, in turn,... READ MORE