LexisNexis® Legal Newsroom
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...

Williams Mullen: Preparing for a Data Breach – What to Know about Breach Notification

By Kelsey S. Farbotko Data breaches are at the forefront of the news, and many companies, including those dominant in the health care industry, have found themselves front and center in the headlines. Although recent news stories have focused their attention on attacks on major, nationwide companies...

This is Real Law: Preventive Measures: Arguing for — and Against — New Options for Patients and Public Health

The path to political office frequently starts at a law school. That observation stems from the number of lawyers who, election after election, end up sitting in Congress and in statehouses across the country. The current share of U.S. senators holding J.D.s, for example, is 53—more than half of...

Barnes & Thornburg LLP: Amarin Pharma Preemptively Sues FDA over 1st Amendment Rights

On Thursday, May 7, Amarin Pharma took the unprecedented step of proactively suing the U.S. Food and Drug Administration (FDA) over the agency’s alleged infringement of the company’s First Amendment Rights. The case arises from Amarin’s desire to market its product, Vascepa, for uses...

DLA Piper Health Systems Alert: MACRA: 3 Compliance Implications For Medicare Providers

By: Karen Nelson Much has been written about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its repeal of the Sustainable Growth Rate formula for physician compensation and the potential gainsharing safe harbor. But the Act also includes certain Medicare program integrity provisions...

Barnes & Thornburg: CMS Releases Physician-Level Payment Data Totaling More Than $90 Billion in Medicare Reimbursements for 2013

By Jessica Talati On June 1, the Centers for Medicare & Medicaid Services (CMS) released its second annual installment of Medicare reimbursement data for physicians and other practitioners. The data set contains records for more than 950,000 practitioners who received a collective $90 billion...

Foley & Lardner LLP: CMS Proposes Major Update to Medicaid Managed Care Regulations

By Anil Shankar and Adam J. Hepworth The Centers for Medicare and Medicaid Services (“CMS”) released, on May 26, 2015, the a far-ranging proposal for revising the Medicaid managed care regulations (“ Proposed Rule ”). The number of individuals enrolled in Medicaid managed care...

Foley & Lardner LLP: CMS Proposes Major Update to Medicaid Managed Care Regulations

By Anil Shankar and Adam J. Hepworth The Centers for Medicare and Medicaid Services (“CMS”) released, on May 26, 2015, the a far-ranging proposal for revising the Medicaid managed care regulations (“ Proposed Rule ”). The number of individuals enrolled in Medicaid managed care...

DLA Piper: Federal Court Blocks Rule Restricting Telemedicine Practice In Texas

By Nathan Fish and Frank E. Sheeder A federal court has temporarily enjoined the Texas Medical Board (TMB) from implementing and enforcing a rule restricting the practice of telemedicine pending resolution of an antitrust lawsuit filed by Teladoc, Inc. The temporary injunction represents a small victory...

DLA Piper Health Systems Alert: U.S. Health Care Payment-Driven Transformation Ahead

By David Gruber, MD, MBA* | Healthcare spending is forecast to increase from US$3 trillion in 2014 to US$5.2 trillion in 2023, reflecting a compound annual growth rate of 5.9 percent. US healthcare expenditures on a per capita basis are 1.9-2.6 times the amount spent by other developed nations despite...

DLA Piper Health Systems Alert: Payment-Driven Transformation Ahead For U.S. Healthcare

By David Gruber, MD, MBA* Healthcare spending is forecast to increase from US$3 trillion in 2014 to US$5.2 trillion in 2023, reflecting a compound annual growth rate of 5.9 percent. US healthcare expenditures on a per capita basis are 1.9-2.6 times the amount spent by other developed nations despite...

Steptoe & Johnson PLLC: Under Stark, ‘Value’ Doesn’t Mean ‘Expensive’

The federal Stark law prohibits physician referrals of “designated health services” payable by Medicare to entities with which the physician or an immediate family member has a financial relationship, unless the arrangement meets an exception. Enforcement initiatives aim at extending the...

Barnes & Thornburg LLP: Antitrust Enforcement For Market Allocation By Michigan Hospitals

By Julie Veldman On June 25, 2015, the United States Department of Justice (DOJ) and the Michigan Attorney General (Michigan AG) sued four Michigan hospital systems for entering into agreements with a competitor to unlawfully allocate territories for the marketing of competing healthcare services...

Barnes & Thornburg LLP: HIPAA Settlement – Improper Storage Of EPHI

By Stacy L. Cook On July 10, 2015, the Office for Civil Rights (OCR) announced a HIPAA settlement with St. Elizabeth’s Medical Center (SEMC), a tertiary care hospital in Brighton, Massachusetts. SEMC has agreed to pay $218,400 and adopt a robust corrective action plan. The settlement is the...

Foley & Lardner LLP: Congress Wows With Medicare Telehealth Parity Act Of 2015, But Will It Succeed?

Rep. Mike Thompson (D-CA) and co-sponsors Rep. Gregg Harper (R-MS), Rep. Diane Black (R-TN), and Rep. Peter Welch (D-VT) announced, on July 7, 2015, the introduction of the Medicare Telehealth Parity Act of 2015 , forward-looking, bi-partisan legislation intended to modernize the way Medicare pays for...

Williams Mullen: Health Care Providers Lacked Standing to Sue as ERISA Beneficiaries: Rojas v. Cigna Health and Life Insurance Company

By Mark S. Thomas The U. S. Court of Appeals for the Second Circuit has affirmed a dismissal of claims by two physicians and their medical practice asserting standing under ERISA to enjoin an insurer from removing them from its coverage network. Rojas v. Cigna Health and Life Insurance Company , Case...

Williams Mullen: Affirming the Need to Fix the Medicare Appeals Backlog: The AFIRM Act of 2015

By: Kelsey S. Farbotko If you are one of the many health care providers wanting to appeal a Medicare contractor’s reimbursement decision, you may need to be prepared for a long wait. Over the last few years, the backlog of appeals to the administrative hearing level has grown into an untenable...

Sands Anderson: Electronic Health Records -- Improving Care or Complicating Litigation?

By Matthew L. Curtis and Michelle L. Warden Electronic Health Records (EHR) were generally promised to decrease costs and improve health-care outcomes. Setting aside whether those promises were well founded, EHR have posed new challenges for litigators. What makes sense in a clinical setting may not...