Articles and Blogs

As has been widely reported, on July 21, 2016, the Antitrust Division of the DOJ filed two separate complaints to block both Anthem’s acquisition of Cigna and Aetna’s acquisition of Humana, alleging both acquisitions violate the federal antitrust laws. In both cases, the parties have decided to fight the DOJ’s challenge. Originally, both cases were scheduled…Read More

On August 4, the Office for Civil Rights (“OCR”) announced a $5.55 million settlement with the largest fully integrated health care system in Illinois. The settlement is the largest HIPAA settlement ever by a single entity and follows two recent settlements with university health systems in Oregon and Mississippi that were $2.7 million and $2.75…Read More

On August 5, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued an Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) adopting the updated labor market area delineations based on the 2010 census. The updated labor market area delineations became effective October 1, 2014. The Final Rule effectively caused, among other changes, several…Read More

The 9th Circuit Court of Appeals just issued a blockbuster ruling in U.S. ex rel. Swoben v United Healthcare et al., ruling that United Healthcare, WellPoint, Aetna and other major health insurance providers must answer to a whistleblower’s complaint that they defrauded the Medicare Advantage program. The Medicare Advantage Program, also known as Medicare Part…Read More

On July 22, 2016, the Center for Clinical Standards and Quality/Survey & Certification Group released a memorandum that revised Chapter 7 of the State Operations Manual (“SOM”) and provided guidance on its policy to immediately impose federal remedies when a deficiency of a certain type is cited. The remedies are in addition to a civil…Read More

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued a favorable Advisory Opinion, No. 16-07, of an arrangement that offers Medicare Part D beneficiaries discounts on prescriptions for an erectile dysfunction drug that is statutorily excluded from coverage under Part D (the “Arrangement”). While OIG concluded that the Arrangement could…Read More

On August 2, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a Proposed Rule establishing three new mandatory retrospective bundled payment models and creating an incentive payment program for cardiac rehabilitation services. In this Proposed Rule, CMS also outlined several proposed changes to the recently implemented Comprehensive Care for Joint Replacement (“CJR”) program. The…Read More

Background On August 2, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule (the “Proposed Rule“) to create three new episode payment models (“EPMs”) covering services provided to Medicare beneficiaries admitted to certain Inpatient Prospective Payment System (“IPPS”) hospitals for heart attacks, coronary bypass surgery or surgical treatment of hip or…Read More

On August 5, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released a Survey and Certification Memo (“S&C Memo”) on protecting resident privacy and prohibiting abuse-related photographs and recordings by nursing home staff.¹  Recent news stories have reported nursing home staff taking unauthorized photographs or video recordings of nursing home residents, sometimes in compromised…Read More

The Michigan Supreme Court recently declined to review, and thus affirmed, a Michigan Court of Appeals’ (“COA”) decision in which the COA held that Michigan law allows a cause of action for wrongful termination in violation of public policy under MCL 333.20176a(1)(a) of the Public Health Code, which prohibits discharge of employees reporting malpractice by health professionals….Read More