Articles and Blogs

Executive Summary On April 26, 2013 CMS released proposed rules for implementing Section 3133 of the Affordable Care Act (“ACA”).  Starting in 2014, these proposed rules will begin a series of substantial reductions in Disproportionate Share Hospital (“DSH”) payments to hospitals.  Most payments under the new DSH program will be from a set pool of…Read More

HHS Issues Rule on DSH Payments On May 13, CMS released a proposed rule on the health reform law’s reductions to Disproportionate Share Hospital (“DSH”) payments. The rule would temporarily shield states that have decided to expand Medicaid from deeper DSH cuts in fiscal years 2014 and 2015. The rule comes a month after the White House’s…Read More

On April 30, 2012, the Wisconsin Court of Appeals decided Brooten v. Hickok Rehabilitation Services, LLC, No. 2012AP1940, unpublished slip opinion, further limiting the enforceability of standard liability waivers used by local businesses.  The decision made clear that “negligence” or “negligent” are not “magic words rendering an exculpatory clause valid.” In Brooten, the plaintiff was…Read More

Three new FCA cases of interest were reported in the last few weeks. One was discussed previously on FCADefense.com in Toumey Loses Stark/FCA Case Again by Drew Howk. Another, Ulysses, Inc. v. United States is yet another example of the growing trend of failed FCA counter-claims by the Government in response to contract litigation. The Third, Fresenius Medical…Read More

Earlier this year, we told you about a recent case from Kentucky in which a federal court found that it was not reasonable for a plaintiff to expect his employer to accommodate his lifting restrictions by spreading essential lifting requirements among the plaintiff’s co-workers.

HHS Releases Hospital Price Information for Common Procedures On May 8, HHS released publicly available information about hospital charges. The data set includes information on the 100 most common inpatient procedures. The data shows that hospital fees vary widely – sometimes 10 to 20 times what Medicare normally reimburses, for the same procedure.  The release of…Read More

Executive Summary On May 8, 2013, the Department of Health and Human Services Office of Inspector General (“OIG”) issued an updated version of its Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs (“Updated Bulletin”).  In September of 1999, the OIG published its original bulletin on this topic designed…Read More

On Tuesday, April 30, 2013, U.S. Customs and Border Protection (“CBP”) began implementing an automated version of Form I-94, Arrival/Departure Record, at air and sea ports of entry.  Form I-94 provides foreign travelers with evidence that they have been lawfully admitted to the United States, which is necessary to verify alien registration, immigration status and…Read More

Jury verdicts in False Claims Act litigation are rare. Two in the same case are rarer still. On May 8, 2013, after just over four hours of deliberation, a jury in the Federal District Court of South Carolina returned a verdict for the Government, finding that the Tuomey Healthcare System violated both the Stark law…Read More

Please find below the frequently asked questions (“FAQs”) the Centers for Medicare & Medicaid Services (“CMS”) recently released concerning therapy caps and advanced beneficiary notice of noncoverage (“ABNs”).