Articles and Blogs

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

by David B. Honig and Brian C. Betner CMS Announces Further Delay of Repayment Rule To be published in the February 17, 2015 Federal Register, CMS has extended its deadline for finalizing the Affordable Care Act’s (“ACA”) 60-day payback rule. This is the rule that requires a Medicare or Medicaid provider to return an identified overpayment within 60…Read More

To be published in the February 17, 2015 Federal Register, CMS has extended its deadline for finalizing the Affordable Care Act’s (“ACA”) 60-day payback rule. This is the rule that requires a Medicare or Medicaid provider to return an identified overpayment within 60 days of its identification. On day 61, the overpayment becomes a violation of the False…Read More

The Timeline Recently, HHS Secretary Sylvia Burwell announced an ambitious timeline for transitioning away from the fee-for-service payment system to one based on value.  Specifically, HHS’s goal is for 30% of all Medicare provider payments to be in “alternative payment models” by 2016 and for 50% of Medicare provider payments to be in alternative payment…Read More

Six- to Nine-Month SGR Patch Likely as Deadline Looms With a March 31 deadline approaching, congressional committees continue to meet and discuss how to fix the Medicare Sustainable Growth Rate (“SGR”) physician payment formula. However, health care industry lobbyists now agree that a six-to nine-month “patch” of the existing formula is more likely than lawmakers reaching…Read More