The Balanced Budget Act of 2015 (“BBA”) passed on November 2, 2015 provides that, effective January 1, 2017, “applicable items and services” (other than items and services furnished by a dedicated emergency department) furnished by an off-campus outpatient department of a provider (“Off-Campus…
The Health and Human Services’ Office of Civil Rights (“OCR”) recently published a final Regulation (“Regulation”) that implements the nondiscrimination requirements of Section 1557 of the Patient Protection and Affordable Care Act.[1] Beginning on July 18, 2016, discrimination in health care…
Following up on a previous client alert item, a federal jury recently found W. Carl Reichel, former president of Warner Chilcott, not guilty on June 17, 2016 of conspiring to pay kickbacks to doctors in exchange for writing prescriptions. The jury deliberated two days before delivering a not guilty…
The Indiana General Assembly passed legislation during the 2015 General Session directing certain boards to establish protocols and standards for prescribing controlled substances for pain management treatment that “complement” existing rules for physicians.[1] Those boards include: the Board of…
Hospitals which have discovered violations in their submissions for payment under Medicare and Medicaid may now pause before reporting the mistake and determine if the violation was “material” to the government’s conditions for payment. If the mistake was not material, then the False Claims Act…
Aetna has claimed victory in a four year-old lawsuit against Bay Area Surgical Management, LLC, after a civil jury hit the California medical group with a $37.4 million dollar judgment.
The victory capped a month-long trial against 10 defendants, including surgical centers and the organization's…
On November 2, 2015, the Centers for Medicare and Medicaid Services (“CMS”) issued a Final Rule titled “Medicaid Program; Methods for Assuring Access to Covered Medicaid Services” following the recent Supreme Court case, Armstrong v. Exceptional Child Care Center, where the Court held that a…
On November 2, 2015, President Obama signed the Bipartisan Budget Act of 2015 (Pub. Law 114-74) into law. The Act includes many provisions aimed to reduce federal debt, but only a few specifically affect health care. Perhaps one of the most significant health care implications involves a change in…
Warner Chilcott USA Sales, LLC, has agreed to plead guilty in federal court to felony criminal charges of paying kickbacks to physicians in return for prescribing seven of its drugs. The subsidiary of multibillion-dollar international pharmaceuticals company Allergan, was also accused of…
On July 16, 2015, CMS issued a proposed rule revising the Long-Term Care Facility Medicare and Medicaid participation requirements. These proposed revisions would serve as a widespread update to the participation requirements which have not been comprehensively reviewed and updated since 1991,…
Earlier this year, CMS published a Medicare notice titled Clarification of Ordering and Certifying Documentation Maintenance Requirements (Change Request 9112), which clarifies the term "access to documentation" in the Medicare Program Integrity Manual (Pub. 100-08, Chapter 15, Section 15.18).
Under…
In a federal grand jury investigation into illegal physician kickbacks paid by a laboratory, Circuit Court Judge Cohen, writing for the U.S. Court of Appeals for the Third Circuit, affirmed the U.S. District Court for the District of New Jersey’s order of contempt against a physician and his…
