Articles and Blogs

The Federal Government has reinforced its expanded theory of false claim liability for quality matters by settling allegations against a hospital that a physician’s lack of qualifications to perform certain surgical procedures should be considered a false claim, regardless of the patient’s outcome. As part of the settlement, the hospital defendant paid the Government $840,000…Read More

On March 13, 2012, the Department of Health and Human Services (“HHS”) announced that it had reached a settlement with Blue Cross Blue Shield of Tennessee (“Blue Cross”) arising from potential violations of the Privacy and Security Rules under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  Notably, HHS learned of the circumstances…Read More

Recently, a Pennsylvania-based physician group practice successfully defended an employment discrimination suit, thanks in part to its robust coding review process and auditing of its physicians’ prescribing habits. The physician plaintiff filed a discrimination suit under the Americans with Disabilities Act (“ADA”), the Age Discrimination in Employment Act and the Pennsylvania Human Relations Act.  The…Read More

The U.S. Supreme Court handed down its opinion yesterday in the case of Mayo Collaborative Servs., dba Mayo Med. Labs., et al. v. Prometheus Labs., Inc. (No. 10-1150) (March 20, 2012) (see PDF here).  The Court reversed the U.S. Court of Appeals for the Federal Circuit and held that the patent claims at issue merely…Read More

As a means of improving care to residents residing in Medicare/Medicaid nursing facilities, CMS announced on March 15, 2012 an initiative to help reduce avoidable hospitalizations.  Organizations interested in participating in this initiative must submit an application to CMS by June 14, 2012. The goal of the initiative is to improve care for residents of…Read More

Three and a half months ago, Congress included language in the National Defense Authorization Act (“NDAA”) declaring that TRICARE network providers will not be subject to OFCCP’s jurisdiction solely on the basis of their TRICARE network agreements.  The NDAA did not, however, address OFCCP coverage over health care providers in any other context, nor did…Read More

Three and a half months ago, Congress included language in the National Defense Authorization Act (“NDAA”) declaring that TRICARE network providers will not be subject to OFCCP’s jurisdiction solely on the basis of their TRICARE network agreements.  The NDAA did not, however, address OFCCP coverage over health care providers in any other context, nor did…Read More

The Office of Inspector General (“OIG”) issued its first opinion of 2012 on March 8th and posted it on its website yesterday.  In Advisory Opinion #12-01, the OIG issued a favorable opinion regarding a health system’s (“Health System”) proposal to form a wholly-owned group purchasing organization (“GPO”) to be the primary GPO for the Health…Read More

Last month the Centers for Medicare & Medicaid Services (CMS) published proposed rules for reporting of overpayments. These proposed rules, if adopted and strictly interpreted, could effectively create a twenty-year statute of limitations under the False Claims Act.

As expected earlier this month, the Centers for Medicare & Medicaid Services (CMS) have just released guidance for health facilities wishing to utilize specific features now available in the 2012 Life Safety Code (LSC).  As previously discussed, the updated LSC provides new ways for nursing facilities to adopt a more home-like setting.  The recent changes…Read More