Articles and Blogs

In a May 15, 2017 7-1[1] decision authored by Hon. Justice Kagan, the U.S. Supreme Court held that the Kentucky Supreme Court’s “clear statement rule” – that an agent can deprive her principal of the rights of access to the courts and trial by jury through an arbitration agreement only if expressly provided in the…Read More

On May 12, 2017, a massive cyber attack affecting health care organizations across the world prompted the United States Department of Health and Human Services (“HHS”) to issue a warning to U.S. health care organizations. The attack apparently first began in England, causing information systems at health care organizations throughout the country to become infected with…Read More

Senate Begins Work on AHCA Senate Republicans began working on the House-passed American Health Care Act (“AHCA”) this week. Several expected changes to the measure include increasing funding for rural hospitals that lose subsidies under Affordable Care Act (“ACA”) repeal, providing a larger share of tax credits to lower income consumers nearing Medicare age (aged…Read More

On May 10th and May 12th, respectively, CGS Administrators, LLC (“CGS”) and Wisconsin Physician Services, Inc. (“WPS”) issued clarifications related to the MACs’ Local Coverage Determinations (“LCDs”) for polysomnography and other sleep studies. Click here for background on these LCDs. Due to efforts by state hospital associations, the MACs recognized that some hospitals relied on…Read More

On May 1, 2017, the United States Court of Appeals released an important decision interpreting the False Claim Act’s (“FCA’s”) materiality requirement in light of the Supreme Court’s 2016 decision in Universal Health Services Inc. v. United States ex rel. Escobar. The case, United States ex rel. Petratos v. Genentech, revolved around allegations regarding the cancer…Read More

Title VII of the of the 21st Century Cures Act (the “Act”) underscores the importance of evidence-based programs and practices for diagnosing, preventing, treating and recovering from mental and substance use disorders. Title VII amends the Public Health Service Act to ensure that such programs reflect the increased knowledge obtained through the progress in science…Read More

If HIPAA covered entities thought the increased rate of enforcement actions at the beginning of 2017 by the Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) was an anomaly, a flurry of settlement announcements by OCR in April indicate the trend may continue. The three recent enforcement actions discussed below demonstrate…Read More

In a decision released May 4, 2017, the Wisconsin Supreme Court held that personal injury attorneys obtaining medical records on behalf of their clients are exempt from statutory certification and retrieval fees (Moya v. Healthport Technologies, LLC, 2017 WI 45, ¶ 2.). The plaintiff was involved in a motor vehicle accident and retained counsel to…Read More

AHCA Passes the House On May 4, the American Health Care Act (“AHCA”) passed the House of Representatives by a vote of 217 to 213. The bill now moves to the Senate where lawmakers have already indicated that they intend to write their own bill instead of taking up what passed in the House. The…Read More

Wisconsin Physician Services, Inc. (“WPS”), the Medicare Administrative Contractor (“MAC”) for J5 (Iowa, Kansas, Missouri and Nebraska) and J8 (Indiana and Michigan) recently issued a local coverage determination (“LCD”), LCD (L36839), revising accreditation requirements for polysomnography and other sleep studies. Historically, the LCD stated that a hospital could use The Joint Commission (“TJC”) accreditation to…Read More