Williams Mullen: OIG 2014 Work Plan Focuses On Compounded Pharmaceuticals Reimbursed By Medicare

By Brian C. Vick The Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) included two items in its recently-released 2014 Work Plan indicating a new focus on the quality and safety of compounded pharmaceuticals reimbursed by Medicare. Pharmaceutical...

Barnes & Thornburg LLP: OIG Work Plan 2014: Takeaways for Hospitals

By Gayland Hethcoat With the release of its work plan for fiscal year 2014 on Jan. 31, 2013, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has provided insight on the agency’s current enforcement priorities in Medicare, Medicaid, and other HHS programs...

Norton Rose Fulbright: CMS Offers New Resources and Guidance on 2-Phase Approach to Sunshine Act Reporting

By: Benjamin Koplin , Selina Coleman and R. Jeffrey Layne The Centers for Medicare & Medicaid Services (CMS) has posted new resources to its "Open Payments" website to clarify its recently announced two-stage approach to registration and data submission. These resources include: ...

DLA Piper Health Care Regulatory and Policy Update -- Week of March 24, 2014

SGR/Legislative Action – On March 11, Senate Finance Committee Chairman Wyden (D-OR) introduced his version of legislation to permanently repeal and replace the sustainable growth rate (SGR), the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 (S. 2110). CBO scored the...

Barnes & Thornburg LLP: Another Round Of HIPAA Audits

By Stacy Cook The Office for Civil Rights (OCR) recently announced that it will be sending surveys to approximately 1,200 organizations in preparation for conducting HIPAA audits. The HIPAA audits are mandated by the HITECH Act. According to the OCR, the surveys will be sent to about 800 covered...

Barnes & Thornburg LLP: President Obama Signs Bill Extending Physician Medicare Rates And Delaying ICD-10 And RAC Audits Under The 2-Midnights Rule

By Nita Garg On April 1, President Obama signed the Protecting Access to Medicare Act of 2014. This legislation extends current Medicare physician reimbursement rates and delays implementation of the ICD-10 code for a full year. Previously, hospitals were to be ICD-10 compliant by October 1, 2014;...

DLA Piper Alert: Federal Agencies Propose Health IT Regulatory Framework, Seek Stakeholder Input and Participation In New Initiatives

By Mary B. Langowski and Kristen E. Ratcliff A little more than five years after the passage of the Health Information Technology Economic and Clinical Health (HITECH) Act, the Food and Drug Administration, Federal Communications Commission and the Office of the National Coordinator for Health IT have...

Steptoe & Johnson PLLC: False Billing Leads To Record Settlement In Medicare/Medicaid Fraud Case

The United States Attorney for the Southern District of West Virginia has announced a record $4.675 million settlement with a medical lab for false billings to Medicare and to West Virginia Medicaid. R. Booth Goodwin, of Charleston, WV, said in his press release that Calloway Laboratories of Woburn,...

Steptoe & Johnson PLLC: Physicians in Whistleblower Suits Need Not Exhaust Peer Review Remedies

A recent decision of the California Supreme Court removed a long-standing procedural limitation on physician suits against hospitals arising from peer review actions. In the recent decision, the California Supreme Court held that a physician need not exhaust hospital-based or judicial remedies before...

Williams Mullen: CMS Proposes Rule That Would Expand Its Authority To Audit Medicare Advantage Plans

By Brian C. Vick O n April 30, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule to update payment policies and rates for inpatient hospitals (the “Proposed Rule”) that includes a provision with significant future implications for sponsors...

Williams Mullen: OIG 2014 Compendium Highlights Need For Improved Controls For Pharmacy Claims Submitted To Medicare Part D Plans For Payment

By Brian C. Vick and C. Elizabeth Hall In its March 2014 Compendium of Priority Recommendations (the “Compendium”), the Office of the Inspector General of the United States Department of Health and Human Services (“OIG”) identified a number of prescription drug-related priorities...

Foley & Lardner LLP: Hospitals Urging SCOTUS to Limit False Claims Act Penalties

What do a moving company and a hospital association have in common? The False Claims Act (FCA). The American Hospital Association along with the United States Chamber of Commerce and the Pharmaceutical Research and Manufacturers of America recently submitted an amici curiae brief in support of petitioners...

Foley & Lardner LLP: SEC's MCDC Initiative - The Clock is Ticking

By David Y. Bannard Not-for-profit health care providers that have borrowed on a tax-exempt basis within the last five years should be aware of the Securities and Exchange Commission’s (SEC) Municipalities Continuing Disclosure Cooperation (“MCDC”) Initiative. The MCDC Initiative...

DLA Piper: Don’t Forget the Sept. 23 Deadline to Ensure Your Business Associate Agreements Comply with the HIPAA Omnibus Final Rule

By Marcia L. Augsburger Under the Health Insurance Portability and Accountability Act (HIPAA) Omnibus Final Rule published January 25, 2013, 78 Fed.Reg. 5566, Covered Entities (CEs) with Business Associate Agreements (BAAs) that were entered on or before January 25, 2013 and that were not modified...

Norton Rose Fulbright: Physicians Payments Sunshine Act Data 33 Percent Unpublishable, Penalties Next?

By Benjamin Koplin , Selina Coleman and R. Jeffrey Layne Despite extending the dispute-and-resolution deadline to account for the days that the Centers for Medicare & Medicaid Services (CMS) pulled down the reporting system, the public Physician Payments Sunshine Act website is still expected...

Steptoe & Johnson PLLC: CMS Final IPPS Rule Effective Oct. 1, 2014

By Jami K. Suver, Of Counsel In August 2014, the Centers for Medicare and Medicaid Services (CMS) issued a final inpatient prospective payment system (IPPS) rule for fiscal year 2015, applicable to inpatient stays at general acute care and long-term care hospitals (LTCH). The rule applies to discharges...

DLA Piper: Bankruptcy Sales for Distressed Hospitals: 4 Questions to Ask Before You Begin

By Thomas R. Califano , Rachel Nanes and Daniel G. Egan Over the last several years, a wide range of healthcare companies, among them hospitals, home health agencies and continuing care facilities, have faced financial distress as a result of declining revenues, high operating costs, reduction in...

Norton Rose Fulbright: CMS Offers Settlement Of Inpatient RAC Denials

By Mark Faccenda On August 29, 2014, the Centers for Medicare and Medicaid Services (“ CMS ”) announced that certain providers with pending appeals of specified inpatient-status claims denied by Medicare contractors may elect to receive partial payment on those claims in exchange for the...

DLA Piper Health Systems Alert: BYOD: Cool But Dangerous – 3 HIPAA Security Rule Challenges, 7 Key Precautions

By Peter F. McLaughlin From reliable surveys and less dependable anecdotes, opinions point to the almost inevitable expansion of BYOD – bring your own device – as a cost-saving model for employers. Advisors assure company decision makers that direct savings will flow by avoiding the...

DLA Piper: Healthcare Industry Compliance In A Shifting World: Putting It All Together

By: Frank E. Sheeder , Karen Nelson and Keri L. Tonn Health industry clients face regulatory and enforcement challenges on multiple fronts. It can be difficult to prioritize and allocate resources properly when government agencies’ initiatives are constantly shifting. The first, fundamental...

DLA Piper: Ebola And Infectious Disease Control – Key Points For Hospitals And Health Systems

By Lara Compton and Joshua Kaye Dr. David Relman, a professor of infectious disease, microbiology and immunology at Stanford University's medical school, was quoted recently saying of the Ebola virus: “As best we can tell right now, it is quite possible that every major city will see at...

DLA Piper Health Systems Alert: When A State Agency Strays Into Antitrust Liability: 4 Practical Tips About Professional Self-Interest

By Steven Levitsky and Lesli C. Esposito Are you a practicing physician who sits on a state licensing board? Is your business affected by a state board with practicing physicians on it? If you said yes to either question, you should read on. Actions of state agencies are normally immune from...

Ballard Spahr LLP: Health Plan ID Program Suspended

By Edward I. Leeds Late on October 31, the Centers for Medicare and Medicaid Services (CMS) Office of E-Health Standards and Services announced that it was suspending the program that required all health plans to register for a health plan ID number to be used in certain electronic transactions. This...

DLA Piper: Binding Arbitration in Managed Care Contracts - 6 Tips to Tailor Your Dispute Resolution Provisions

By Stephen L. Goff and John Barnes The Affordable Care Act is moving millions of previously uninsured patients into commercial managed care health plans. As the healthcare system grapples with complexity of this shift, the size of disputes between healthcare providers and managed care payers, in terms...

DLA Piper: Government Turns Up the Heat With the False Claims Act – 5 Action Steps for Healthcare Providers

By Savaria B. Harris and Mitka T. Baker Forbes magazine has dubbed 2014 “The Year of the Whistleblower.” For healthcare providers, this designation has translated into millions of dollars in fines and penalties and the initiation of criminal investigations. Just last month, the Health...