Articles and Blogs

Last week, the Seventh Circuit Court of Appeals handed down its decision in  US ex rel. Presser v. Acacia Mental Health Clinic, LLC.¹  The FCA case was brought by a nurse practitioner whistleblower who alleged that services being provided were not medically necessary. The court affirmed dismissal under Rule 9(b) for failure to plead fraud with…Read More

Ever since the Supreme Court’s June 16, 2016 decision in Universal Health Services, Inc. v. United States ex rel. Escobar, a False Claims Act (“FCA”) case upholding the theory of implied certification, significant discussion has commenced regarding the Court’s “new” FCA materiality standard. How the appellate courts define materiality under the FCA, post-Escobar, will have…Read More

On August 30, 2016, the Wisconsin Court of Appeals (“Court”) affirmed the circuit court’s decision that a plaintiff had not stated a claim on which relief could be granted in an action against a hospital and its employees for alleged violations of Wis. Stat. § 146.82, regarding the confidentiality of health care records, and Wis….Read More

The recently passed Wisconsin Act 265 (the “Act”) establishes a new statutory requirement that all “pain clinics” obtain and maintain a special certification to be issued by the Wisconsin Department of Health Services (“DHS”), Division of Quality Assurance (“DQA”). Any organizations engaged in providing pain clinic services should carefully assess whether this requirement applies to…Read More

Since at least 2012, we have written about the NLRB’s focus on employer handbook policies that it considers to be unlawfully overbroad.  You can read about these past developments here.  Overbroad policies can have a chilling effect on employees’ right to engage in concerted activities for their mutual aid and protection.  The NLRB’s pronouncements apply…Read More

On August 22, 2016, the Department of Health and Human Services Office of the Inspector General (“OIG”) released additional guidance (“IRO Guidance”) on relevant principles that should be used to assess the independence of Independent Review Organizations (“IROs”) performing reviews required as a condition of Corporate Integrity Agreements (“CIAs”). This most recent update reflects the…Read More

On May 12, 2016, the Occupational Safety and Health Administration (“OSHA”) issued a final rule (“Final Rule”) amending 29 C.F.R. § 1904.35 to improve tracking of workplace injuries and illnesses. The Final Rule seeks to increase the accuracy of reports by prohibiting retaliation and adverse action against employees that inappropriately deters or discourages employees from reporting work-related…Read More

Update: The IRS has modified the effective date of Rev. Proc. 2016-44 to extend the transition period by 6 months. The revision allows an issuer to apply the safe harbors in Rev. Proc. 97-13, as modified and amplified, to a management contract entered into before August 18, 2017 and that is not materially modified or…Read More

Enrollment will soon be closing for the Centers for Medicare and Medicaid Services’ (“CMS”) new Comprehensive Primary Care Plus (“CPC+”) payment model. Building on the success of the Comprehensive Primary Care model, CPC+ aims to strengthen primary care by creating new incentives for providers to invest in resources to improve the quality and efficiency of…Read More

On August 23, 2016, eight plaintiffs jointly sued the federal Department of Health and Human Services (“HHS”) disputing the definition of the term “sex” in recent HHS regulations implementing the Affordable Care Act’s (“ACA”) non-discrimination provisions. A link to the Complaint is here.  The HHS regulations, which, among other things, protect patients who receive federally…Read More