Articles and Blogs

On February 23, 2015, the U.S. Department of Labor announced a rule change to be issued February 25, 2015 that ensures that all eligible employees in same-sex marriages will enjoy the same rights and protections under the Family Medical Leave Act (“FMLA”) as employees in opposite-sex marriages.

A clearly irate Fifth Circuit Court of Appeals reversed summary judgment granted on behalf of Shell Exploration and Development Company, for the second time, and remanded with an order that the case be assigned to a new judge. In United States ex rel. Little v. Shell Exploration the Fifth Circuit, for the second time, reversed the trial court’s…Read More

A recent case out of the Northern District of Illinois Federal Court, US ex rel. Oughatiyan v. IPC the Hospitalist Company, Inc., demonstrates the high risk inherent in evaluation and management (E&M) coding for health care providers.

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 for…Read More

This month’s announcement of the recent Anthem Data Breach sent shockwaves through the health care industry with some experts referring to 2015 as the “year of the health care hack.” Those who collect and store health data have been racing to strengthen security protocols and to understand their risk exposure. In a first-of-its-kind case in the…Read More

CMS Delays Final Rule on Collecting Medicare Overpayments On Tuesday, February 17, CMS announced through the Federal Register that it will postpone until February 16, 2016 the implementation of a proposed rule that would require Medicare providers under Parts A and B of Title XVIII to return overpayments within 60 days. CMS first proposed the rule, which includes…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 his…Read More

Written by David B. Honig and Delphine P. O’Rourke Assertion of affirmative defenses creates risk for clients, attorneys and law firms.  Treating False Claims Act litigation like any other litigation will lead to the unnecessary expenditure of time and money and potentially sanctions. A recent decision out of the Southern District of Texas, United States ex rel. King v Solvay S.A.,¹ is an excellent primer in…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 Physician…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, are…Read More