Health Care

CMS has yet to issue regulations required under the federal Physician Payment Sunshine Act even though they were due on October 1, 2011. 

BioWorld Perspectives recently published an article by Mintz Levin attorneys Sam Davenport and Matt Hurley entitled “Avoiding Litigation While Protecting Your Interests,” which discusses the essential steps for companies to take after entering into a collaboration, license, or supply agreement to avoid ending up in litigation down the road.

In an Advisory Opinion long awaited by many in laboratory industry, the OIG concluded that a proposed arrangement that would have allowed physicians to profit from their own referrals for anatomic pathology services would “pose more than a minimal risk of fraud and abuse.” 

Manufacturers of pharmaceuticals, devices, and biological or medical supplies are well aware of an impending January 1, 2012 deadline to start collecting information for reports mandated by the federal “Physician Payments Sunshine Act,” which was part of health care reform legislation.

The Office of Inspector General released its Work Plan for Fiscal Year 2012 describing the focus of its activity for the next fiscal year. 

ML Strategies has posted its weekly Health Care Reform Update providing timely information on implementation of the Affordable Care Act and other state and federal administrative and legislative activities related to health care reform.

In a  Medicare Part C (or “Medicare Advantage”) False Claims Act settlement announced by the Milwaukee-Wisconsin Journal-Sentinel on September 25th, an operator of a Germantown Wisconsin Medicare Advantage plan and its parent agreed to pay $4.8 million to settle allegations that the company improperly paid eligible individuals to enroll in the Medicare Advantage plans, then misled them about the scope of coverage. 

The split among the federal circuit courts over the “implied certification” of liability under the federal False Claims Act (FCA) is figuratively banging at the Supreme Court’s door.

ML Strategies has posted its weekly Health Care Reform Update providing timely information on implementation of the Affordable Care Act and other state and federal administrative and legislative activities related to health care reform.

On September 18, the Office of Inspector General (OIG) for the Department of Health & Human Services “tweeted” about its Physician Education Training Materials, which are designed to teach physicians how to comply with the Federal fraud and abuse laws.  OIG has increasingly used Twitter to publish information that may be of interest to providers.

In this article "Texas Law Gives Privacy More Muscle than HIPAA", published by Law360 on September 16, 2011, Mintz Levin attorney Dianne Bourque is quoted regarding the aggressive new Texas health care privacy law.

Eliminating fraud, waste, and abuse in health care has long been a top government priority, but — as demonstrated by a series of events this week — it likely will garner even more attention as the government seeks to reduce the federal deficit by $1.5 trillion over the next ten years. Providers should closely monitor the developments.

CMS has announced the publication of a proposed rule that will require HIPAA-covered laboratories to make test results available to patients no later than 180 days after the rule's effective date, which will be 60 days after publication in tomorrow's Federal Register. 

In a recent advisory opinion, the OIG allowed a hospital to share telemedicine resources with another hospital, in the interest of promoting new models of consultation and improving patient care by reducing unnecessary patient transfers.

When qui tam relators/whistleblowers file suit under the civil False Claims Act (FCA), they are “standing in the shoes” of the government to allege that the government has suffered damages due to fraud. 

This case involved “John Doe,” a 65-year-old registered level-three sex offender. After serving time in jail, Mr. Doe was released to a homeless shelter. After sustaining serious injuries during a mugging, he was hospitalized and later discharged to a nursing home.