On March 14, 2018, Governor Eric J. Holcomb signed into law a measure that provides for significant streamlining of the prior authorization requirements for health care services covered by commercial health insurance plans in Indiana that are not otherwise governed by ERISA. House Enrolled Act 1143…
Governor Eric Holcomb is expected to sign legislation aimed at curbing Indiana’s growing opioid crisis, one of Governor Holcomb’s top agenda items for the 2018 legislative session. Senate Enrolled Act 221 (“SEA 221”) requires prescribers to have access to and utilize INSPECT, a state-sponsored…
The Centers for Medicare and Medicaid Services (“CMS”) recently issued guidance (MLN Matters SE17033 – Revised) re-emphasizing that Medicare should not pay an acute care hospital for services furnished to a Medicare beneficiary, when the beneficiary is still an inpatient of another facility, such…
CMS’ recent MLN Connects e-Newsletter reminds providers of their obligation to report changes in ownership to CMS and highlighted the 2016 Office of Inspector General (“OIG”) study that revealed providers may not be properly reporting changes in ownership.
OIG’s 2016 study titled “Medicare:…
In a recent announcement by the U.S. Department of Health and Human Services (“HHS”), Office of Civil Rights (“OCR”), the OCR was clear to make a point that just because a business closes during an OCR investigation, does not mean that the business’ obligation for any HIPAA violations ends. To make…
A December 2017 Office of Inspector General (“OIG”) Advisory Opinion favors a gainsharing arrangement whereby a hospital will share with specific neurosurgeons a percentage of the hospital’s cost savings from spinal surgeries performed at the hospital. [1] This Advisory Opinion marks the OIG’s…
On February 9, 2018, both the House and the Senate voted to pass, and President Trump signed into law, the Bi-Partisan Budget Act of 2018 (the “Act”, House Resolution 1892). Most notably this Act extends federal appropriations through March 23, 2018, preventing government shutdown for another…
The Health and Human Services’ Office of Civil Rights (“OCR”) recently entered into yet another Resolution Agreement after investigating a serious breach incident involving the electronic protected health information (“e-PHI”) of over 2 million patients that was maintained by a Florida health care…
On January 23, 2018, the U.S. Drug Enforcement Administration (“DEA”) issued a final rule announcing another step to increase opioid addiction treatment.[1] Effective January 22, 2018, nurse practitioners (“NP”) and physician assistants (“PA”) are eligible to become DATA-Waived "qualifying…
In December 2017, the Office of Inspector General (“OIG”) entered into settlement agreements with four hospitals to resolve allegations of violations of the Emergency Medical Treatment and Labor Act (“EMTALA”).[1] EMTALA requires hospitals to provide an appropriate screening examination and…
A Department of Justice internal memo dated January 10, 2018 reflects a significant policy change regarding the DOJ’s election to dismiss certain qui tam lawsuits in which the government declines to intervene. The Memo (a copy of which can be found here) notes that the number of qui tam actions…
A June 2017 decision by a federal district court in the District of Columbia determined that a reference laboratory cannot rely on the ordering physician’s determination to establish medical necessity for testing paid for under Medicare, Medicaid, or other federal health care programs.[1] In…
