Articles and Blogs

Several FCA opinions have been issued since the last FCA Update. The most interesting is a District of Nevada case, US ex rel Guardiola v Renown Health. Renown Health was the parent company for two other corporate defendants that provided acute health care services. The relator was Renown’s Director of Clinical Compliance. She alleged Renown improperly billed “zero-day…Read More

On Friday, October 24, 2014, the IRS released an advance version of Notice 2014-67, (1) adding a new 5-year safe harbor to Revenue Procedure 97-13 (“Rev. Proc. 97-13”) and providing for the inclusion of quality-based incentive payments in management and service contracts for facilities financed with tax-exempt bond proceeds; and (2) offering interim guidance for determining…Read More

HHS Announces $840 Million in Quality Improvement Grants On October 23, CMS announced the CMS Innovation Center will grant $840 million to hospitals and doctors to provide improved care while reducing costs. The grants will support 150,000 clinicians over four years with incentives, tools and information as part of the ongoing effort to move away from…Read More

The Indiana Court of Appeals recently ruled the trial court erred in dismissing a patient’s Intentional Infliction of Emotion Distress (“IIED”) claim based on the lack of subject matter jurisdiction.  In this claim, the patient was admitted to the hospital while unconscious and under the influence of phencyclidine, a medication commonly known as the date…Read More

As the first quarantine period in Texas passes without additional infections, the focus is on improving preparedness for Ebola while ensuring accurate information is made available to the public. To support preparedness efforts, the CDC and other health care organizations have taken steps to provide health care organizations and providers around the country with critical information…Read More

With concerns over the spread of Ebola, hospitals and health care providers face a unique situation as employers and care providers. Just as a few years ago employers geared up to deal with Pandemic Flu and a few decades ago employers were dealing with AIDS/HIV in the workplace, many of the same precautions and guidance…Read More

Executive Summary In recently issued, virtually identical Advisory Opinions Nos. 14-07 and 14-08, the Department of Health and Human Services Office of the Inspector General (“OIG”) opined that licensed insurers offering Medigap policies to Medicare beneficiaries may contract with preferred hospital organization network hospitals for discounted Medicare inpatient deductibles and, in turn, issue premium credits…Read More

Overview The Department of Health & Human Services Office of Inspector General (“OIG”) recently released a Special Advisory Bulletin on the fraud and abuse implications of pharmaceutical manufacturers offering copayment coupons to reduce or eliminate the cost of out-of-pocket copayments for brand-name drugs.  The Special Advisory Bulletin and the concurrent OIG Office of Evaluations and Inspections…Read More

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued a proposed rule that adds to and amends the Anti-Kickback Statute safe harbors and provides guidance regarding the Civil Monetary Penalty rules for beneficiary inducements and gainsharing (“Proposed Rule”).1 The Proposed Rule addresses several issues regarding the way providers interact with…Read More

Executive Summary On October 17, 2014, the Centers for Medicare & Medicaid Services (“CMS”) announced1 the extension of the November 2, 2011 interim final rule with comment that established waivers of some federal fraud and abuse laws as applied to Accountable Care Organizations (“ACOs”) participating in the Medicare Shared Savings Program (the “Program”). Without this…Read More