Articles and Blogs

On December 23, 2016, the Department of Health and Human Services, Office of Inspector General (“OIG”) released a report (the “Report”) detailing a case review of inpatient rehabilitation (“rehab”) hospitals.1 The Report indicates that for 39 out of 426 rehab hospital stays reviewed, the patient was unable to participate in and benefit significantly from intensive…Read More

As the health care industry and the related body of health law shift like tectonic plates, Hall Render attorneys are committed to providing practical counsel and insight to health care providers. Below is a compilation of key developments from 2016 that will continue to impact the health care industry in 2017. As the new year…Read More

Senate Takes First Step Towards ACA Repeal On January 4, the U.S. Senate took the first step towards repeal of the Affordable Care Act (“ACA”). The Senate voted 51-48 to advance a fiscal 2017 budget resolution (S. Con Res 3) that allows Congress to use the parliamentary procedure known as budget reconciliation to repeal parts…Read More

Contract management plays an important role in the day-to-day operations of any hospital or health system. With increased governmental scrutiny on hospital and physician arrangements, the need to ensure and track compliance across a health system’s portfolio of contracts is vital. An effective contract management program helps a health system to implement appropriate controls to…Read More

The role of pharmacists and pharmacies as integral cogs in the patient care continuum continues to grow, thanks in no small part to incentives encouraging integrated and coordinated care designed to enable improved outcomes at lower cost. From Medicare bundled payment initiatives that include drug costs to third party payor reimbursement reductions driven by pharmacy…Read More

On December 7, 2016, the Senate passed the 21st Century Cures Act (“Cures Act”), which revised Section 603 of the Bipartisan Budget Act of 2015 (“Section 603”) to provide an exception for off-campus provider-based departments (“PBDs”) that were mid-build or under development prior to November 2, 2015. The Cures Act was signed into law by President…Read More

Health care real estate assets are often referred to as being located “on-campus” or “off-campus.” While real estate market participants may differ in their criteria for referring to a property as on- or off-campus, the Centers for Medicare & Medicaid Services (“CMS”) defines a hospital campus in the provider-based regulations at 42 C.F.R. § 413.65(a)(2)…Read More

On December 14, 2016, the Department of Justice (“DOJ”) released a report on fraud statistics regarding recovery amounts for False Claims Act (“FCA”) violations in fiscal year 2016 (“Report”). Reaching $4.7 billion from settlements and judgments, this year’s recovery is the third highest annual recovery in FCA history. Health care fraud accounts for a substantial…Read More

On December 20, CMS posted for public inspection a final rule establishing three new Episode Payment Models (“EPMs”). Two of the EPMs pertain to cardiac care. The third EPM pertains to orthopedic care.  CMS will officially publish the rule on January 3, 2017. The Cardiac-Related EPMs The first cardiac-related EPM is for episodes of care…Read More

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinion 16-11,1 which provided a favorable opinion of a Medicare Supplemental Health Insurance plan’s (the “Plan’s”) proposed arrangement (the “Arrangement”) through which a preferred hospital network would offer Plan policyholders (“Policyholders”) who elect to use a network hospital for inpatient…Read More